Provider Demographics
NPI:1437312295
Name:CROSSROADS COUNSELING CENTER PLLC
Entity Type:Organization
Organization Name:CROSSROADS COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:HODGDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-512-5131
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04351-0251
Mailing Address - Country:US
Mailing Address - Phone:207-512-5131
Mailing Address - Fax:888-293-3442
Practice Address - Street 1:726 WESTERN AVE.
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:ME
Practice Address - Zip Code:04351
Practice Address - Country:US
Practice Address - Phone:207-512-5131
Practice Address - Fax:888-293-3442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty